Practice influencing the outcomes of peritonitis in patients on peritoneal dialysis (PD)

Abstract

Peritonitis is a severe complication in patients receiving peritoneal dialysis (PD). Repeated and prolonged episodes of peritonitis can lead to structural and functional alterations to the peritoneal membrane, which could lead to inefficient PD, sometimes necessitating a permanent transfer to haemodialysis (HD). Timely intraperitoneal (IP) administration of the appropriate dose of antibiotics, in accordance with the International Society for Peritoneal Dialysis (ISPD) peritonitis guidelines, remains the cornerstone of treatment for PD-associated peritonitis.

Peritonitis was identified as one of the core clinical outcomes important to patients, caregivers and clinicians. Therefore, effective treatment and prevention of peritonitis are crucial in improving peritonitis outcomes. However, peritonitis outcomes can vary by patient characteristics (i.e., residual kidney function, comorbidities), peritonitis characteristics (i.e., bacterial virulence factors and species) and modifiable treatment practices (i.e., treatment strategies that are organism- and centre-specific, unit-specific peritonitis rates). Therefore, the studies in this thesis aimed to examine multiple factors, including institution, patient, drug and centre-related factors that can affect peritonitis outcomes. This thesis also contains published manuscripts presented as chapters.

In conclusion, the studies in this thesis outline current clinical practice and examine the practice variations, management, and preventive approaches of PD-associated peritonitis in Australia and New Zealand. The studies examined five factors: drug, dialysis, patient, organism-specific and centre-related factors affecting peritonitis outcomes. The findings from these studies provide the basis for future multi-centre studies for preventing and treating peritonitis to improve outcomes in patients receiving PD.